Effects of bariatric surgery on obesity associated gastroesophageal reflux disease: Insights from a systematic review and network meta-analysis

Table 1 Basic information of included studies

Ref.	Country	Comparison (n)	Follow-up	Outcome
Delko et al[12], 2024	Switzerland	RYGB (40) vs OAGB (40)	12 months	%EWL, GERD remission, GERD onset, complication
Eskandaros et al[13], 2021	Egypt	RYGB (40) vs OAGB (40)	12 months	BMI reduction, %EWL, change in PPI usage
Ospanov et al[14], 2024	Kazakhstan	OAGB (50) vs OAGB + antiflux (100)	24 months	BMI reduction, complication
Biter et al[15], 2017	United States and Netherland	RYGB (71) vs SG (74)	12 months	BMI reduction, %EWL, GERD onset, complication
Kermansaravi et al[16], 2024	Iran and Spain	OAGB (49) vs OAGB + antiflux (49)	12 months	GERD remission, GERD onset
Lee et al[17], 2025	New Zealand	RYGB (22) vs SG (21)	90 months	Change in PPI usage
Level et al[18], 2021	Venezuela	RYGB (19) vs OAGB (9)	60 months	BMI reduction, %EWL, GERD remission1
Musella et al[19], 2021	Italy	OAGB (28) vs SG (30)	12 months	BMI reduction, change in esophagitis
Olmi et al[20], 2022	Italy	SG (140) vs SG + antiflux (138)	12 months	BMI reduction, GERD onset, change in PPI usage, change in esophagitis, complication
Salman et al[21], 2023	Egypt	RYGB (31) vs OAGB (31)	6 months	BMI reduction, %EWL, GERD onset, change in PPI usage
Shivakumar et al[22], 2018	India	OAGB (101) vs SG (100)	36 months	%EWL, GERD onset, complication
Snyder et al[23], 2016	United States	SG (36) vs SG + antiflux (41)	12 months	BMI reduction, %EWL, GERD onset
Robert et al[24], 2024	France	RYGB (118) vs OAGB (114)	60 months	%EWL, GERD onset, change in PPI usage, complication
Wågen Hauge et al[25], 2025	Norway	RYGB (54) vs SG (55)	60 months	BMI reduction, change in PPI usage, change in esophagitis, complication
Salminen et al[26], 2022	Finland	RYGB (119) vs SG (121)	120 months	%EWL, GERD remission, GERD onset, change in PPI usage, complication
Kraljevic et al[27], 2025	Switzerland	RYGB (73) vs SG (69)	120 months	BMI reduction, GERD remission, GERD onset, complication

¹Although initially included, this study was later discovered with only one patient with preoperative gastroesophageal reflux disease and therefore did not contribute to the gastroesophageal reflux disease remission analysis.

BMI: Body mass index; PPI: Proton pump inhibitor; GERD: Gastroesophageal reflux disease; OAGB: One-anastomosis gastric bypass; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; %EWL: Percent excess weight loss.

Table 2 League table showing pairwise comparisons of included interventions

Interventions
Body mass index reduction [MD (95%CI)]
	OAGBantiflux	RYGB		SG	SGantiflux
OAGB	2.60 (0.16-5.04)	0.10 (-1.47 to 1.68)		-0.83 (-2.73 to 1.07)	-1.96 (-4.61 to 0.70)
OAGBantiflux	-	-2.50 (-5.40 to 0.40)		-3.43 (-6.52 to -0.34)	-4.56 (-8.16 to -0.95)
RYGB	-	-		-0.94 (-2.28 to 0.41)	-2.06 (-4.35 to 0.23)
SG	-	-		-	-1.12 (-2.98 to 0.73)
Percent excess weight loss [MD (95%CI)]
		RYGB	SG		SGantiflux
OAGB		-3.70 (-7.24 to -0.16)	-7.71 (-12.58 to -2.83)		-9.71 (-19.36 to -0.05)
RYGB		-	-4.01 (-8.47 to 0.45)		-6.01 (-15.46 to 3.45)
SG		-	-		-2.00 (-10.34 to 6.34)
GERD remission [RD (95%CI)]
	OAGBantiflux	RYGB		SG	SGantiflux
OAGB	-0.41 (-3.71 to 2.89)	2.95 (-1.21 to 7.10)		1.61 (-3.10 to 6.31)	0.85 (-4.79 to 6.49)
OAGBantiflux	-	3.35 (-1.95 to 8.66)		2.01 (-3.73 to 7.76)	1.26 (-5.27 to 7.79)
RYGB	-	-		-1.34 (-3.55 to 0.87)	-2.09 (-5.90 to 1.72)
SG	-	-		-	-0.75 (-3.86 to 2.35)
GERD onset [RR (95%CI)]
	OAGBantiflux	RYGB		SG	SGantiflux
OAGB	-1.43 (-2.71 to -0.15)	-1.15 (-1.94 to -0.36)		0.32 (-0.69 to 1.33)	0.42 (-1.09 to 1.92)
OAGBantiflux	-	0.28 (-1.23 to 1.78)		1.75 (0.12-3.38)	1.84 (-0.13 to 3.82)
RYGB	-	-		1.47 (0.69-2.25)	1.57 (0.21-2.92)
SG	-	-		-	0.09 (-1.02 to 1.20)
Change in proton pump inhibitor usage [RR (95%CI)]
		RYGB	SG		SGantiflux
OAGB		-0.03 (-0.22 to 0.16)	0.14 (-0.11 to 0.38)		0.01 (-0.35 to 0.38)
RYGB		-	0.16 (0.00-0.32)		0.04 (-0.27 to 0.35)
SG		-	-		-0.12 (-0.39 to 0.15)
Change in esophagitis [RR (95%CI)]
		RYGB	SG		SGantiflux
OAGB		0.40 (0.34-0.47)	0.45 (0.39-0.50)		0.23 (0.17-0.29)
RYGB		-	0.04 (0.01-0.08)		-0.17 (-0.21 to -0.13)
SG		-	-		-0.21 (-0.23 to -0.20)
Complication [RD (95%CI)]
	OAGBantiflux	RYGB		SG	SGantiflux
OAGB	-1.28 (-3.11 to 0.56)	-0.24 (-1.04 to 0.57)		-0.25 (-1.12 to 0.62)	1.15 (-0.58 to 2.88)
OAGBantiflux	-	1.04 (-0.96 to 3.04)		1.03 (-1.00 to 3.06)	2.43 (-0.10 to 4.95)
RYGB	-	-		-0.01 (-0.64 to 0.61)	1.38 (-0.24 to 3.00)
SG	-	-		-	1.40 (-0.10 to 2.89)

GERD: Gastroesophageal reflux disease; MD: Mean difference; OAGB: One-anastomosis gastric bypass; RD: Risk differences; RR: Risk ratio; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy.

Table 3 Surface under the cumulative ranking curve ranking table presenting the probabilities of each surgery being ranked for each outcome

Outcomes	Rank	1	2	3	4	5
Body mass index reduction	OAGB	1.61%	44.33%	32.52%	13.73%	7.82%
	OAGBantiflux	88.63%	4.66%	2.68%	2.06%	1.97%
	RYGB	6.30%	40.17%	44.64%	6.86%	2.04%
	SG	1.28%	6.37%	15.23%	67.62%	9.50%
	SGantiflux	2.19%	4.47%	4.94%	9.73%	78.67%
Percent excess weight loss	OAGB	91.00%	7.45%	1.27%	0.29%	-
	RYGB	3.03%	78.64%	14.01%	4.33%	-
	SG	0.81%	5.34%	64.39%	29.47%	-
	SGantiflux	5.16%	8.58%	20.34%	65.92%	-
GERD remission	OAGB	0.00%	0.22%	0.50%	71.59%	27.69%
	OAGBantiflux	0.01%	0.14%	0.28%	27.79%	71.78%
	RYGB	99.99%	0.01%	0.00%	0.00%	0.00%
	SG	0.00%	93.61%	6.26%	0.12%	0.02%
	SGantiflux	0.00%	6.03%	92.96%	0.50%	0.51%
GERD onset	OAGB	13.99%	21.40%	64.24%	0.37%	0.00%
	OAGBantiflux	0.16%	0.43%	1.76%	38.40%	59.24%
	RYGB	0.00%	0.00%	0.14%	59.24%	40.62%
	SG	31.69%	54.52%	13.40%	0.40%	0.00%
	SGantiflux	54.16%	23.65%	20.45%	1.60%	0.14%
Change in Proton pump inhibitor usage	OAGB	13.22%	25.75%	31.91%	29.12%	-
	RYGB	1.34%	16.80%	46.09%	35.77%	-
	SG	67.47%	26.74%	5.16%	0.63%	-
	SGantiflux	17.97%	30.71%	16.85%	34.48%	-
Change in esophagitis	OAGB	2.98%	5.14%	16.60%	75.29%	-
	RYGB	34.43%	40.61%	18.14%	6.82%	-
	SG	51.39%	39.37%	8.67%	0.58%	-
	SGantiflux	11.20%	14.88%	56.60%	17.31%	-
Complication	OAGB	1.29%	69.35%	17.62%	11.30%	0.44%
	OAGBantiflux	0.26%	3.41%	3.07%	2.51%	90.75%
	RYGB	0.08%	15.07%	47.82%	33.82%	3.21%
	SG	0.01%	10.86%	31.27%	52.27%	5.59%
	SGantiflux	98.36%	1.31%	0.23%	0.09%	0.01%

GERD: Gastroesophageal reflux disease; OAGB: One-anastomosis gastric bypass; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy.